Retirees to rural areas won’t find docs

Sunday

Sep 2, 2012 at 6:00 AM

By Jeff Barnard THE ASSOCIATED PRESS

Nina Musselman had no trouble finding a family doctor when she retired to rural Oregon nine years ago to be closer to her children. But then that doctor moved away, leaving her to search for another who would take Medicare.

After a year of going from doctor to doctor, she finally found one who stuck.

As record numbers of baby boomers go into retirement, many are thinking about moving from the places they needed to live to make a living, and going someplace warmer, quieter or prettier.

If they choose small towns like Grants Pass, 250 miles south of Portland, they could well have a hard time finding a family doctor willing to take Medicare, even supplemental plans, rather than private insurance.

There are several reasons boomers, the 78 million Americans born between 1946 and 1964, could face difficulties finding a doctor if they retire to small towns over the next 20 years.

First, many primary care doctors prefer to live and work in urban areas because of greater cultural opportunities, better schools and job opportunities for spouses.

Also, Medicare pays rural doctors less per procedure than urban physicians because their operating costs are supposedly less. That makes rural doctors less likely to accept Medicare patients.

With cuts to Medicare reimbursement for doctors targeted under the federal health care overhaul, the shortage is likely to get even worse, said Mark Pauly, professor of health care management at the University of Pennsylvania.

That is, unless increasing reimbursements for nurse practitioners and physicians’ assistants encourages those providers to take up the slack, Pauly said.

If the Medicare cuts go through, “the doctors are saying: “We’re out of here,’ ” Pauly said. “The least they are saying is: ‘We’ll treat Medicare patients like we treat Medicaid patients,’ which is mostly not.”

Still, there is some good news, depending on where you live.

Pauly said the Affordable Care Act “puts a lot of emphasis on wellness programs and primary care. Nurses, especially nurse practitioners, are intended to play a major role there.”

Nationwide, the 22.5 percent of primary care doctors who practice in rural areas roughly matches the 24 percent of Medicare patients living there, said Dr. Roland Goertz, chairman of the American Academy of Family Physicians board.

A survey of academy members nationwide shows 83 percent take new Medicare patients. But there is an overall shortage of primary care physicians that still makes it hard for retirees to find a family doctor.

The real problem, he said, is that the health care system “has not supported a robust, adequate primary care workforce for over 30 years.”

According to the American Association of Medical Colleges, rural areas need about 20,000 primary care doctors to make up for the shortages, but only about 16,500 medical doctors and 3,500 doctors of osteopathy graduate yearly.

“We are always trying to recruit doctors. We are barely keeping even,” said Lyle Jackson, the medical director at the Mid-Rogue Independent Physician Association, a cooperative of doctors in Josephine County, where Musselman lives.

Taking part in the Medicare Advantage program, which pays a higher rate to doctors than standard Medicare, helps, but is still not enough, said Jackson, a former family physician.

A 2009 survey of doctors in the Oregon Medical Association showed concern over Medicare reimbursement rates topping the list of 23 issues, with 79 percent rating it as very important, said Joy Conklin, an official at the association.